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Medicine and the Arts

Commentary on Space Age Dreaming

Waldman, Reid A. MD; Waldman, Steven D. MD, JD, MBA

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doi: 10.1097/01.ACM.0000585380.73341.27
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Carlos Almaraz, a Chicano artist, poet, political activist, and member of Los Four, the influential Los Angeles art collective, is credited with bringing Chicano art to the attention of the Anglo-American art world.1 A man of deep convictions and deep conflicts, much of his art is concerned with trying to reconcile his bisexuality with his strong Catholic upbringing.2 At the height of his career, Almaraz contracted HIV, and in 1989 he succumbed to AIDS-related complications. Just prior to his death, Almaraz created Space Age Dreaming, a triptych depicting his musings on his impending death, its effect on his family, and its relationship to his aforementioned internal conflict. Through critical evaluation of this work, one can see that the emotional distress Almaraz experienced as a result of his HIV diagnosis can serve as a microcosm for the emotional turmoil that inevitably develops when patients are told that they have HIV or other serious life-altering illnesses.

The triptych is meant to be viewed from right to left. In the first panel (far right), the observer can see Almaraz self-depicted as the bunny-man joining hands and seeking comfort from a female figure, Elsa Flores, his wife. Below them, religion is depicted as a kneeling praying figure and an angel who are tasked with sending Almaraz on his final journey. His impending death is signaled by the skull beneath them. Like all terminal patients, Almaraz is saddened by what he is leaving behind as he makes the inexorable march towards death. As he realizes that he must make his final journey alone, Almaraz changes his persona to the lonesome traveler with a hat heading off through the city without religion or his loved ones (as seen in the bottom left corner of the right-hand panel). Another important motif from this panel is the depiction of an ill-defined bridge in the background. This is the iconic bridge at Echo Park that is depicted in many of Almaraz’s paintings (such as the last panel of this triptych) as his spiritual oasis. Unlike the final panel of this triptych (far left), where the bridge at Echo Park is peaceful and serene, in this first panel it is juxtaposed with a busy Los Angeles street, representing the idea that the impact of his HIV diagnosis is so all-encompassing that even his most sacred, safe place has been adulterated for him.

In the center panel, the lonesome traveler is depicted several times as he is buffeted by the events rushing around him on the mean city streets. The presence of the devil’s mask looking down on Almaraz undoubtedly represents his personal feelings about his sexual behaviors: Was it not his self-judged sin that set him on this journey in the first place? The devil’s mask also highlights Almaraz’s ongoing internal conflict with his sexuality and the negative impact it has had on both him and his loved ones. Alone on his final journey, the lonesome traveler can’t help but wonder if the devil who has been with him in life will be with him after death. In this panel, a feminine figure holding an infant is seen sadly watching over Almaraz as he nears his death. This woman again is Almaraz’s wife, Elsa Flores, who is holding their daughter, Maya. Even though they want to be with him and he with them, his past behaviors and ultimately his HIV keep them apart.

The final (leftmost) panel is much different from the first two. Gone are the chaotic brushstrokes and the hectic city streets that previously represented Almaraz’s distress and loss of control. This unease is replaced by a calm acceptance of the inevitable. The peaceful depiction of the bridge at Echo Park, a place of spiritual importance to the artist, is eerily similar to Almaraz’s many previous depictions of this famous Los Angeles landmark. Almaraz and his wife can be seen together both on the bridge and in a boat on the lake, reunited in spite of everything that has transpired in their life together. As he comes to the end of his journey, Almaraz is finally at peace, having reconciled the constant guilt, turmoil, and conflict that were his life’s companions. He is no longer alone, and the devil is but a distant memory. Almaraz, no doubt sensing the comic tragedy of his life’s role, dons the dunce’s cap of the buffo or comic jester and jauntily exits stage right behind the magenta curtain.

While Almaraz clearly intended this painting to depict in vivid detail the complex array of emotions he experienced living with HIV and awaiting his untimely death, it also is very representative of the emotional turmoil that many patients experience after receiving a life-altering diagnosis. Like Almaraz, they initially feel isolated and alone. Additionally, they experience self-blame and are often hypercritical and regretful about previous life choices. Fortunately, like Almaraz, many of these individuals eventually come to terms with their diagnosis, and most find solace in their final days. This painting serves to remind clinicians about the sheer magnitude of the emotional impact associated with receiving the diagnosis of a serious life-altering illness and to emphasize that emotional support for these patients is a critical component of providing them with excellent medical care.


1. Wilson W. The troubled gift of Carlos Almaraz. Los Angeles Times. June 27, 1992. Accessed July 29, 2019.
2. Cuevas S, Shifflet J. Carlos Almaráz’s art was steeped in the dualities of sexual and ethnic identity. The Frame. Published August 21, 2017. Accessed June 6, 2018.
Copyright © 2019 by the Association of American Medical Colleges